Medical advances mean greater numbers of HIV infected patients are living longer. More women with HIV will survive into and beyond their menopausal years. Although there is little known about how menopause and HIV affect each other, new research is educating doctors to help their patients cope with HIV and menopause – and into the postmenopausal years.

Researchers in Belgium recently conducted a controlled case study to learn how HIV treatments affected menopausal women. This study focused on African women due in part to the alarming number of HIV patients but the results are no less beneficial to female HIV patients elsewhere.

HIV and menopause study in African women
The study was small, involving only 43 HIV patients and 23 unaffected women, but is still a major breakthrough in both understanding HIV in older women as well as discovering the outcomes of long-term HIV treatments as life expectancy rates increase. The average age of women with HIV was 44 and differed little from the average age of 45 for non-HIV patients. There were very few differences in the women’s body mass index (BMI) readings, menstrual periods, smoking, and drug using habits.

Participants were given a series of questions and given blood, done density, and cardiovascular tests. Moreover, these women answered questions about their socio-economic status, reproductive history, and quality of life. The women did not know the true goal of the study; that their HIV or non-HIV status was a factor that affected their menopause.

HIV and menopause
The initial findings of this study show that women with HIV had a lower socio-economic income, which often presents additional challenges in obtaining healthcare and medicines. In this small sample, all but one of the HIV infected patients were receiving some form of treatment, the most common being protease inhibitors (50%), a third with NRTI inhibitors, and 20% with a further combination of NRTI and NNRTI options.

There was no difference in menopausal age for either group of women; menopause is not found to be directly affected by an HIV diagnosis. HIV infected women reported only slightly more anxiety levels than their HIV-free counterparts do.

One important difference indicated more HIV infected women had a lower total bone mineral density, yet only one HIV patient in the study was diagnosed with osteoporosis. Lack of Vitamin D was common for both groups; 67% of HIV patients and 45% of non-HIV participants were not getting enough. One finding showed HIV patients tended to have increased risk for cardiovascular disease, based on hip/waist measurements, which pointed to increased weight gain during menopause.

The final results showed that in this small group of African women, who reported low rates of smoking and drug use, and high antiretroviral treatment use, bone mass was usually less than that of non-HIV patients, and HIV infected women faced increased risk of developing heart disease with age.
There is still much work to be done to get a better understanding of how HIV survivors can expect to age during and beyond menopause.

The most exciting part of this small but influential study is that HIV is no longer an automatic death sentence as it was just two or three decades ago. For women with HIV, menopause is not necessarily any more difficult than it is for other women. However, as the life expectancies continue to lengthen for women in the developing and developing world, research into how menopause and HIV influence each other will ensure that more women live longer and healthier lives.

‘Menopause in HIV infected patients: a retrospective case control study” Rozenberg, Serge (Belgium) – CHU St. Pierre
Aurelie Joris, Yannick Manigart, Stephane Dewit, Tarik El Mahi, Marianne Tondeur, Serge Rozenberg, Departments of Obstetrics and Gynecology, Infectious diseases, Nuclear medicine, Clinical Biology – CHU Saint-Pierre Universite Libre de Bruxelles, Belgium, 322 rue Haute, 1000 Brussels, Belgium.


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